5.3 Intravenous Fluid Therapy, Total Parenteral Nutrition, and Blood Products

Intravenous fluid therapy is a crucial aspect of patient care. It involves administering various solutions to maintain fluid balance, correct electrolyte imbalances, and provide essential nutrients. Understanding the types of IV solutions and their effects is key for nurses.

Blood products and total parenteral nutrition play vital roles in treating specific conditions. These therapies require careful monitoring and administration to prevent complications and ensure optimal patient outcomes. Nurses must be familiar with the components and indications for each type of therapy.

Intravenous Fluid Therapy

Types of intravenous solutions

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• Crystalloids
  • Isotonic solutions (0.9% sodium chloride, lactated Ringer's) have electrolyte concentrations similar to extracellular fluid and are used for fluid resuscitation and maintenance
  • Hypotonic solutions (0.45% sodium chloride, 5% dextrose in water) have lower electrolyte concentrations than extracellular fluid and are used for fluid maintenance and to treat hypernatremia
  • Hypertonic solutions (3% sodium chloride, 10% dextrose in water) have higher electrolyte concentrations than extracellular fluid and are used to treat severe hyponatremia and increase intravascular volume
• Colloids
  • Natural colloids (albumin, fresh frozen plasma) contain large molecules that remain in the intravascular space and are used to maintain oncotic pressure and expand plasma volume
  • Synthetic colloids (hydroxyethyl starch, dextran) contain large molecules that mimic the effects of natural colloids and are used as an alternative to natural colloids in certain situations

Crystalloids vs colloids

• Crystalloids are small molecules that can pass through capillary membranes, distribute evenly between intravascular and interstitial spaces, are used for fluid resuscitation, maintenance, and correction of electrolyte imbalances, and may cause edema in large volumes
• Colloids are large molecules that remain primarily in the intravascular space, maintain oncotic pressure (which affects osmotic pressure), expand plasma volume, treat hypovolemic shock, and reduce risk of edema

Fluid and Electrolyte Balance

• Fluid balance is maintained through careful administration of IV fluids, considering factors such as osmolarity and osmotic pressure
• Electrolyte balance is crucial for proper cellular function and is closely monitored during IV fluid therapy
• Acid-base balance can be affected by IV fluid administration and must be considered when selecting appropriate solutions

Total Parenteral Nutrition and Blood Products

Components of parenteral nutrition

• Macronutrients
  • Carbohydrates (dextrose)
  • Proteins (amino acid solutions)
  • Lipids (soybean oil, olive oil)
• Micronutrients
  • Electrolytes (sodium, potassium, calcium, magnesium)
  • Vitamins (B-complex, C, A, D, E, K)
  • Trace elements (zinc, copper, selenium, manganese)
• Administered via central line (subclavian, jugular) for long-term or high-osmolarity solutions or peripheral line for short-term or low-osmolarity solutions while monitoring for complications (infection, hyperglycemia, electrolyte imbalances, parenteral nutrition-associated liver disease (PNALD))

Role of blood products

• Packed red blood cells (PRBCs) treat anemia, improve oxygen-carrying capacity, increase intravascular volume, and improve tissue perfusion
• Fresh frozen plasma (FFP) contains clotting factors and proteins, treats coagulopathies, and replaces lost plasma volume
• Platelets treat thrombocytopenia, prevent bleeding, maintain hemostasis, and aid clot formation
• Cryoprecipitate contains high concentrations of fibrinogen, factor VIII, and von Willebrand factor and is used to treat specific coagulation disorders (hemophilia A, von Willebrand disease)
• Careful monitoring for transfusion reactions is essential when administering blood products

Correction of fluid imbalances

• Hypovolemia is treated with isotonic crystalloids (0.9% sodium chloride, lactated Ringer's) to replace lost fluid and restore intravascular volume and colloids (albumin, hydroxyethyl starch) to maintain oncotic pressure and expand plasma volume
• Hypernatremia is treated with hypotonic crystalloids (0.45% sodium chloride, 5% dextrose in water) to dilute excess sodium and restore normal serum levels and free water administration (oral intake, enteral feeding) to promote renal excretion of excess sodium
• Hyponatremia is treated with hypertonic saline (3% sodium chloride) to rapidly increase serum sodium levels in severe cases and fluid restriction and diuretics to promote free water excretion in euvolemic or hypervolemic patients
• Hypokalemia is treated with potassium chloride supplementation added to maintenance fluids or given orally while monitoring for arrhythmias and muscle weakness
• Hyperkalemia is treated with:
  1. Insulin with dextrose to promote intracellular shift of potassium
  2. Calcium gluconate to stabilize cardiac membrane and prevent arrhythmias
  3. Loop diuretics (furosemide) to promote renal excretion of excess potassium
  4. Sodium polystyrene sulfonate (Kayexalate) to bind potassium in the gastrointestinal tract